| NPI | 1124076294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX J2808) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WY 18173C) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2025-04-09 |